There are critical knowledge gaps in our understanding of the patterns and risks of infection in patients treated with maintenance hemodialysis and peritoneal dialysis. Infections are a major cause of mortality, morbidity, and health care utilization in the growing dialysis population. The long-term goal of this proposal is o identify potentially modifiable risk factors related to infections in dialysis patients. This objecive will be accomplished by examining the patterns and associated risk factors for infection using a newly enriched database from a national dialysis provider, Dialysis Clinic, Inc., which contains more detailed and current data on infections and risk factors than has been available previously. The central hypothesis is that there will be differences in infection rates associated with specifi patient-related factors, dialysis facility-related factors, and secular trends such as reimbursement patterns. The rationale is that an analysis of these patterns may identify important modifiable risk factors that could guide future strategies to reduce infections. This wil be investigated by pursuing two specific aims: 1) to describe the incidence, prevalence, microbiology and treatment of both access- and non-access-associated infections in hemodialysis and peritoneal dialysis patients, including secular trends relating to national dialysis reimbursement changes; and 2) to identify potentially modifiable risk factors associated with infections in these patients, both at the patient level (such as iron administration, vascular access, diabetes and other comorbid conditions) and at the dialysis facility level (including the impact of facility size, staffing ratios, and prevention strategies such as vaccination prevalence, skin antisepsis type, and catheter locking solutions). Under the first aim, we will retrospectively analyze DCI data since 2009 for rates of infection both directly related and not related to the dialysis access and we will evaluate these patterns over time and among high-risk subgroups. Under the second aim, we will assess risk factors for infection in multivariable analyses, using patient-level data as well as data ascertained by surveying dialysis facilities to determine policy variables potentially related to infection. The proposed research is significant because it will better illuminate the scope of infections in dialysis patients than prior studies and will identify potentially modifiable risk factors for infection. Ultimately, this research may guide future interventions directed against the factors which are most modifiable and of highest impact.